Citation Nr: 18160447
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 18-46 954
DATE:	December 26, 2018
REMAND
The issue of entitlement to an increased disability rating for coronary artery disease associated with hypothyroidism, currently rated as 60 percent disabling, is remanded.
The issue of entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU), is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1956 to September 1976.
These matters come before the Board of Veterans’ Appeals (Board) on appeal of an April 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan.
1. Entitlement to an Increased Rating for Coronary Artery Disease
The Veteran contends that his service-connected coronary artery disease has increased in severity.  Specifically, the Veteran stated that a private medical examination reflects a workload of 3 METs or less.  See VA Form 9, received October 2018.  
The Veteran was provided a VA examination in October 2017.  The VA examiner provided an interview based METs test and determined that the Veteran’s METs level was greater than three and less than five.  However, the VA examiner stated that the estimated METs level is not due solely to the Veteran’s service-connected cardiac condition.  As rationale, the VA examiner noted that the Veteran’s heart condition is stable and his ejection fraction has improved from 35 percent to 45 percent.  The VA examiner further noted that the Veteran has a history of nonservice-connected COPD and pulmonary fibrosis.  Therefore, the VA examiner noted that the Veteran’s METs level due solely to his service-connected coronary artery disease is greater than five and less than seven.  
The Veteran was provided a private examination in June 2018.  The private examiner stated that the Veteran is “clearly having symptoms of exertional shortness of breath and exertional angina and at a less than a 3 MET work capacity.”  However, the June 2018 private examiner did not address whether the Veteran’s METs level is due solely to his service-connected coronary artery disease or whether the Veteran’s METs level is affected by his nonservice-connected COPD and pulmonary fibrosis.  
In light of the June 2018 private examination, a new VA examination is required so that the current nature and severity of the Veteran’s service-connected disability may be determined.  See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159; see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination); Weggenmann v. Brown, 5 Vet. App. 281 (1993) (VA has a duty to provide an examination when there is evidence that the disability has worsened since the previous examination).  On remand, the VA examiner must address the June 2018 private examination and determine whether the Veteran’s current METs level is due to his service-connected coronary artery disease or due to his nonservice-connected disabilities.  
2. Entitlement to a TDIU
The claim for a TDIU is inextricably intertwined with the Veteran’s claim for entitlement to an increased disability rating for coronary artery disease.  See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). 
Additionally, the Board notes that the record for review may be incomplete.  The most recent VA treatment records are from October 2017.  VA treatment records, even if not in the claims file, are considered part of the record on appeal because they are within VA’s constructive possession.  See 38 U.S.C. § 5103A (2012); Bell v. Derwinski, 2 Vet. App. 611 (1992).  On remand, updated VA treatment records must be obtained and associated with the record.   
The matter is REMANDED for the following action:
1. Obtain all outstanding treatment records relevant to the matters being remanded, to include from October 2017.  
2. After the above development, schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected coronary artery disease.  The record and a copy of this remand must be made available to and reviewed by the examiner.  The examination must include all physical and diagnostic testing deemed necessary by the examiner in conjunction with this request.  The examiner should report all manifestations and functional impairment related to the Veteran’s service-connected coronary artery disease, to include the ability to maintain substantially gainful employment.  
The VA examiner should address the June 2018 private examination reflecting an METs level of less than 3.  The VA examiner should, if possible, determine the Veteran’s METs level due solely to his service-connected coronary artery disease. 
3. After completion of the above, review the expanded record, including the evidence entered since the most recent statement of the case, and determine whether an increased rating for coronary artery disease and entitlement to a TDIU may be granted.  If any benefit sought remains denied, furnish the Veteran and his representative with a supplemental statement of the case.  The appropriate period should be allowed for response before the appeal is returned to the Board.     

 
Jennifer White
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. G. LeMoine, Associate Counsel

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For More Information on Veterans Disability Compensation Benefits! Visit: DisableVeteran.org ~ A Non-Profit Non Governmental Agency

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